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Given the emerging consensus that a history of 3 concussions predisposes athletes to more frequent concussions and increasing recovery times, more attention to the accumulation of concussions in an athlete's history seems warranted. While it is too early to propose hard and fast guidelines, a mechanism for discussing the athlete's participation seems reasonable. Organizations should develop mechanisms for discussing participation when athletes accumulate a pre-determined number (or other factors such as persistent post-concussion syndrome) of concussions. Policies should include who to include (parent, PCP, AD, principal), and when the discussion is triggered. A history of three concussions should trigger consideration of steps that may be necessary to protect the athlete, including retirement from collision sports.

The NH State Advisory Council on Sport-Related Concussion recognizes that insuring resolution of concussion prior to allowing return to sport activity is the basis of safe management of sport concussion. The Council further recognizes that a history of multiple concussions should prompt more conservative management and may warrant consideration of the advisability of continued participation in contact or collision sports.

Recommendations for Consideration of Retirement from Sports